Enable Health Plan Workflow And Process Change Necessary For Accountable Care

Health plan IT systems undergo three kinds of change: information accretion, system tuning, and structure transformation.

Information accretion is simply the addition of new rows of data in databases or XML files in XML based systems. In human terms, it’s like learning new phone number one day or a new joke the next.

System tuning is the gradual increase in performance, such as speed and accuracy that occurs over time. Users tweak settings, create shortcuts, and get faster themselves at use of the system through practice. One of my favorite stories about practice is the psychologist who studied eighty year old cigar makers in Miami, who started when they younger then ten years old. He measured speed and consistency. Guess what. They were still improving! Something like that happens with the “cognitive systems” we create out of combining software and people. In often cases, even badly designed software can gradually become better over time, as folks find tweaks and workarounds and themselves compensate for system design flaws.

What about structural change? That indeed is the hardest. Over time, you learn more and more facts, you get faster and more accurate, but every once in a while, old ways of doing things are no longer sufficient. The world has changes but you have not. At this point you can still in your heels, or you begin the painful job of question fundamental assumptions, in effect, attempting to redefine yourself. IT systems are a lot like this. The “structure” of an IT system is in its database structures (models) and workflow structures. Changing database models is difficult, but it generally well understood in health IT. However, workflow is a very different animal. Many health plan workflows are essentially hardcoded in if-then and case statements in 3rd generation languages such as Java and C#. Have you heard the old joke about how many programmers does it take to change a lightbulb? Only one, but in the morning your toilet and stove are broken. Changing workflow requires changing software and changing software is difficult, expensive, and dangerous.

Unless! Unless workflow is coded using high-level models of workflow, that humans can understand, but which can still be executed by workflow engines. That is modern BPMs give to software development. It is much easier to change software systems after they’ve been designed and deployed, because, essentially, they don’t have to be recompiled, retested, etc.

Take a look at one of my most popular blog posts, A Litmus Test for Detecting Frozen Workflow.


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